Healthcare Provider Details

I. General information

NPI: 1124375639
Provider Name (Legal Business Name): ANDRES CUARTAS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 10/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 NW 107TH AVE # 106
SWEETWATER FL
33172-2510
US

IV. Provider business mailing address

2913 NW 97TH CT
DORAL FL
33172-1085
US

V. Phone/Fax

Practice location:
  • Phone: 305-882-9260
  • Fax:
Mailing address:
  • Phone: 305-882-9260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN21040
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: